Chronic pelvic pain: how does noninvasive imaging compare with diagnostic laparoscopy?
Seema A Tirlapur1, Jane P Daniels, Khalid S Khan
1aWomen's Health Research Unit, Barts and the London School of Medicine, Queen Mary University of London bBarts Health NHS Trust, Newham University Hospital, London cBirmingham Clinical Trials Unit, School of Cancer Sciences, Robert Aitken Institute, University of Birmingham, Birmingham dBarts Health NHS Trust, The Royal London Hospital, London, UK.
Noninvasive imaging like ultrasound and MRI can help diagnose chronic pelvic pain (CPP), offering a safer and cheaper alternative to surgery. These methods aid in initial treatment decisions for CPP, reserving laparoscopy for second-line investigation.
Area of Science:
- Gynecology
- Diagnostic Imaging
- Pain Management
Background:
- Chronic pelvic pain (CPP) affects 38/1000 individuals annually in the UK.
- Coexisting pathologies are common in CPP.
- Diagnostic laparoscopy is the gold standard but reveals no abnormality in up to 40% of cases.
Purpose of the Study:
- To evaluate the diagnostic value of noninvasive imaging (pelvic ultrasound and MRI) for CPP.
- To compare the effectiveness of noninvasive imaging with diagnostic laparoscopy.
Main Methods:
- A literature review was conducted from database inception until January 2015.
- Databases searched included PubMed, MEDLINE, CINAHL, EMBASE, and HYGRECA.
- Studies assessing ultrasound, MRI, and laparoscopy for CPP diagnosis were identified.
Main Results:
- For endometriosis, ultrasound sensitivity ranged from 58% to 88.5%, and MRI sensitivity ranged from 56% to 91.5%.
- Laparoscopy sensitivity was 85.7% in one study using histology as the reference standard.
- Noninvasive imaging offers benefits of being well-tolerated, safer, and more cost-effective than surgery.
Conclusions:
- CPP is multifactorial and often requires a multidisciplinary approach.
- Ultrasound and MRI can provide valuable diagnostic information for CPP.
- Noninvasive imaging can guide initial treatment and help determine the need for surgical intervention.
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